最紊乱的心房颤动波在心房内分布特点及肺静脉隔离对其影响  

Atrial Distribution of Disorganized Electrograms and Impact of Pulmonary Vein Isolation on it in Patients With Chronical Atrial Fibrillation

作　　者：张树龙[1] 迟贤国 黄丽萍[1] 高连君[1] 李世军[1] 林治湖[1] 杨延宗[1] 

机构地区：[1]大连医科大学附属第一医院心内科,辽宁省大连市116011 [2]大连市金州人民医院心内科

出　　处：《中国循环杂志》2005年第4期249-251,共3页Chinese Circulation Journal

基　　金：国家自然科学基金资助项目(30270552)

摘　　要：目的针对心房颤动(房颤)基质消融是房颤消融的最终目标,最紊乱的房颤波(Ⅲ型房颤)所在部位可能为房颤维持的关键所在。本文分析Ⅲ型房颤波在双侧心房的分布特点及肺静脉隔离对其影响。方法11例持续性房颤患者,用普通的电生理检查导管或64极Basket导管分别在上腔静脉、右心房游离壁、右心房后壁、右心耳、右心房间隔部、左心房后壁、左心耳、肺静脉及冠状静脉窦记录2分钟房颤心内电图。根据Wells对房颤电活动的分类,人工计算Ⅲ型房颤占所记录的2分钟心电图的百分比(房颤紊乱指数,DI)。比较肺静脉隔离前及房颤自动终止或电复律前冠状窦口及冠状窦中、远端房颤紊乱指数的变化。肺静脉隔离在房颤中进行。在窦性心律下证实仍然存在心房—肺静脉间电活动传导,在窦性心律或心房刺激下完成肺静脉隔离。结果在所有720次采样中,房颤紊乱指数成双峰分布,第二峰起始点为75%。在左心房后壁(包括肺静脉)采样326次,房颤紊乱指数大于75%占22.4%,在间隔部(包括冠状静脉窦开口部)采样118次,房颤紊乱指数大于75%占37.3%,在心房其它部位(包括右心房游离壁、右心房后壁、上腔静脉、左心耳及冠状静脉窦左房部)采样276次,房颤紊乱指数大于75%占6.2%。左心房后壁及间隔部与心房其它部位比较有统计学差异(P<0.001)。肺静脉隔离导致了冠状静脉窦远端的房颤电活动变化(房颤紊乱指数消融前14.34±25.01,消融后4.62±8.64,P=0.016),而对冠状静脉窦口无明显影响(房颤紊乱指数消融前37.49±38.09,消融后46.83±41.96,P=0.243)。平均随访7个月,6例患者维持窦性心律,5例患者转为阵发性或持续性房颤。结论Ⅲ型房颤多集中在左心房后部,包括肺静脉。肺静脉隔离可降低Ⅲ型房颤在左心房的百分比,而对右心房影响较小。提示Ⅲ型房颤的集中部位可能为房颤维持的关键部位,肺静Objective ： We investigated the atrial distribution of disorganized electrograms during atrial fibrillation（AF） and the effects of pulmonary vein （PV） isolation on it. Methods： Eleven patients with symptomatic persistent AF（ 〉 6 months） who failed to more than one antiarrhythmic drug and AF reoccurred within 30 min after more than one cardioversion were involved in this study. Two minute electrograms at multiple atrial sites were recorded. PV isolation was performed during AF, A disorganization index （DI） was defined as percentage of time during the 2 minute recording when there was absence of discrete complexes and isoelectric intervals （type Ⅲ AF electrogram）. Highly disorganized AF activity was recognized as DI〉75%. Results： AF was terminated in 1 patients during ablation, and restored to sinus rhythm by cardioversion in the remaining 10 patients after PV isolation. Prior to ablation, highly disorganized AF activity focused in the posterior left atrium （LA） including sites at the PV-LA junction （22.4% in posterior LA, 37.3% in septum, 6.2% in others sites）. PV isolation significantly reduced DI values recorded from coronary sinus （14. 3±25 vs 4.6±8.6, P〈0.02）. After a mean follow-up of 7 months, 6 patients were free of AF or not on antiarrhythmic drugs, 5 patients were in paroxysmal or persistent AF. Conclusions： Our data indicate that the posterior LA is involved in the most disorganized electric activity during AF and that may be part of substrate for AF maintenance. Reduced AF disorganization by PV isolation may be associated with modification of substrates in the posterior LA.

关 键 词：心房颤动 肺静脉 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]